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Syphilis is a complex disease caused by the spirochete Treponema
pallidum. It occupies an interesting place in the history of disease,
appearing explosively as a virulent epidemic in Europe during the
age of exploration, a time of intense scientific inquiry. Although
syphilis incidence has waxed and waned over the centuries since,
it has never really abated. Penicillin has been and remains the
therapy of choice.

Unique among the sexually transmitted diseases, syphilis is characterized
by a potential to cause a wide range of systemic manifestations.
It can involve nearly every organ system in a variety of ways acutely
or more commonly in an insidious and chronic fashion. Latent periods
between clinical manifestations may be of variable duration. It
has the potential to cause serious congenital disease and appears
to enhance the transmission of human immunodeficiency virus (HIV).

Syphilis is typically acquired sexually or congenitally. Rare
cases of acquisition through contaminated blood products have been
reported. Syphilis can also be spread by skin or mucosal contact with
an infectious lesion (eg, through nonsexual direct contact such
as skin to skin or kissing). The risk of syphilis following sexual
exposure to an individual with infectious syphilis is probably about
30% and is dependent on a variety of factors, including
the extent and location of disease in the source patient. Long-standing
immunity following infection after treatment does not occur, and
repeated infections are possible.

Most syphilis infections are sexually transmitted; therefore,
measures that prevent sexual exposure, such as condom use or reduction
in the number of sex partners, are effective in reducing the risk
of acquiring syphilis. Syphilis is unique among the sexually transmitted
diseases because of a well-characterized prolonged incubation period
during which infection can be aborted by prophylactic treatment.
After sexual exposure infection may be prevented with penicillin
G benzathine therapy.

Preventive treatment is highly effective and a mainstay of syphilis
control programs. Persons who may have been exposed to syphilis
are contacted and offered preventive therapy. Those who receive
timely preventive therapy will not undergo seroconversion (see later
discussion of serologic testing). Waiting for serologic test results
before treatment is not recommended in patients who report syphilis
exposure, because the opportunity to prevent infection may be missed.
All persons who report exposure should receive preventive treatment,
regardless of serologic test results.